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  • 1. 9 yo female presents c/o right wrist pain after falling off of a horse while at summer camp. She complains of pain with palpation and passive motion of wrist. Ice was placed on injured extremity at scene and she has no other complaints. T:97.8F P:104 R:18 BP:104/78 O2:98% Gen: anxious but NAD HENT: no evid of trauma CV/Lungs:clear, mildly tachycardic, RRR Abd: soft, NT, ND Ext: 2+ radial pulse with god cap refill. Ulnar.Radial, Median nerves intact to motor and sensation. Mild swelling over dorsum of right wrist, TTP, but no obvious osseous abnormality.

2. E P M D No obvious abnormality is seen on two views, but pt remains tender on exam. 3. Solid neurovascular exam Plain films Analgesia If visible separation of epiphysis, will need reduction If suspicion remains and x-rays appear normal, splint and follow up with Ortho in 7 days for repeat films. 4. Salter Harris I is a fracture through the physis with separation of epiphysis. Might not be readily visible on xray for up to one week Do not mistake injury as sprain when it is near a growth plate. If unsure, splint and FU with orthopedics in 7-10 days for repeat films. If treated correctly, complications are rare. 5. d/residency/ortho- teaching/pediatrics/case23/case23edmanagement.htm l v3c05.html eid=21433&quiz=#pic Menkes, J.S. Orthopedic Injuries. Tintinallis Emergency Medicine: A Comprehensive Study Guide Chapter 267


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